Childbirth is a traumatic experience, both emotionally and physically. Childbirth, whether vaginal or caesarean, creates opportunities for bacteria to infect both the parent and the newborn, and sometimes these infections can cause the parent’s immune response to go out of control.
Its extreme reaction to infection, called sepsis, is the third leading cause of death worldwide during or after childbirth. Millions of maternal sepsis occur each year, mostly in low- and middle-income countries. The usual symptoms of sepsis, such as fever, rapid heart rate, and low blood pressure, can appear even during healthy pregnancies and births, making it particularly difficult for doctors to detect and treat in time. . Left untreated, sepsis can lead to tissue damage, organ failure, and ultimately death.
To prevent these infections during a caesarean section, doctors routinely give an antibiotic called azithromycin before starting the operation.A global study in low- and middle-income countries now shows that the same approach may also prevent sepsis in vaginal deliveries. A single dose of azithromycin in people planning a vaginal delivery reduced the risk of sepsis by 35%.Because azithromycin is cheap and can be taken orally, this approach makes sepsis more common during or after childbirth. , which may be a viable way to prevent some cases of maternal sepsis in countries with limited access to healthcare. Results were published Thursday. New England Journal of Medicine.
The study “hopefully allows us to better care for these women and ultimately change the outcome,” says Laura Riley, an obstetrician and gynecologist at Weill Cornell Medicine in New York City. Not involved in her research.
The study followed approximately 30,000 participants from seven countries: Bangladesh, India, Pakistan, Zambia, Kenya, Democratic Republic of the Congo, and Guatemala. Researchers followed the participants for over a month after giving birth. His 1.6% of participants who received antibiotics experienced sepsis compared with 2.5% of him who received no treatment. This was a larger reduction than expected by the study’s architects, and participants experienced minimal side effects. Antibiotics had no effect on neonatal infection or mortality rates.
Alan Tita, an obstetrician and gynecologist at the University of Alabama at Birmingham and lead author of the study, said: “It’s great because it can make a big difference in patient care and outcomes.” The research team had planned to enroll more participants, but early results pushed the study forward. was decisive enough to end in
Michael Santos of the National Institutes of Health Foundation, one of the study’s funding partners, said: “That’s a really nice result.”
If a person survives sepsis, it can cause lifelong damage.
Fortunately, sepsis is often preventable. “I think this study alone is enough to change practice,” says Lindsay Admon, an obstetrician and gynecologist who studies health equity at the University of Michigan. Maternal mortality in the United States has been on the rise since her late 1990s and is more than twice as high as in other wealthy countries. Racial inequality is high here, with a black woman nearly three times more likely to die in childbirth than a white woman, according to the U.S. Centers for Disease Control and Prevention. Admon hopes similar studies will be done in the United States and other high-income countries, but there are still large health disparities.
However, the benefits of prescribing azithromycin for sepsis prevention must be weighed against the consequences of antibiotic overuse. Let them find ways to avoid bacteria. Drug-resistant bacteria are on the rise and they can be deadly. Azithromycin in particular targets a wide range of bacteria, making it effective in childbirth. This trade-off is very important in weighing the benefits of this intervention, said Mercedes-Bonnet Semenas, medical officer in the World Health Organization’s Division of Reproductive Health and Research. He is not involved in the new paper.
“That question was on everyone’s mind and was part of the research plan,” says Santos. The researchers continue to analyze samples taken from participants to determine the drug’s exact effects on naturally occurring bacteria in patients’ bodies, and they expect these results to be published in his 2024 publication. I hope you will.
Preventing sepsis may be worth the risk of contributing to antibiotic resistance in parts of the world where infections during birth are common. said Julie Gerberding, Chief Executive Officer of the Foundation. A global and coordinated effort is needed to get medicines to those who can use them most. WHO can review the results and choose to include the treatment in its essential medicines program and obstetric care guidelines, he said.
Maternal mortality is “an area of high inequality,” she says. “Now this is our chance to tackle a very dangerous aspect of birth.”
